Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Open Qual. 2021 Jan;10(1). doi: 10.1136/bmjoq-2020-000917.
Hypertension is an important modifiable risk factor for cardiovascular disease in patients with diabetes. Despite established guidelines, the percentage of patients meeting the target blood pressure (BP) of <140/90 mm Hg in clinic remains suboptimal. In this project, we sought to improve BP measurement in an outpatient diabetes clinic.Two interventions were performed: (1) Changes were made to the timing of BP measurement during patient intake and (2) An electronic medical record (EMR) alert reminded staff to repeat BP if the initial reading was above target. Baseline data were collected on 4764 patients, with 72.5% meeting their BP target. After implementation of changes to the timing of BP measurement during patient intake, 73.3% of patients met the target (no significant change). However, after implementation of the EMR alert, there was a statistically significant improvement in patients meeting the target BP at 76.8% (p<0.01). This reduction was driven by the high percentage of patients with an initially elevated BP measurement that came down into goal range on repeat measurement. Those who remained above target despite multiple readings could be referred to a new pharmacist-led hypertension clinic to ensure adequate follow-up and medication adjustment.It is important to ensure that in clinic BP measurements are taken correctly and adhere to best practices. Use of a single in-clinic BP measurement may result in overtreatment of hypertension. While timing of BP measurement during patient intake was not important, repeating high BP measurements did improve the number of patients in an outpatient diabetes clinic meeting their BP target.
高血压是糖尿病患者心血管疾病的一个重要可改变的危险因素。尽管有既定的指南，但在诊所中，达到目标血压（BP）<140/90mmHg 的患者比例仍然不理想。在这个项目中，我们试图改善门诊糖尿病诊所的血压测量。进行了两项干预措施：（1）改变患者就诊时测量血压的时间；（2）电子病历（EMR）提醒工作人员，如果初始读数高于目标，则重复测量血压。在收集了 4764 名患者的基线数据后，有 72.5%的患者达到了他们的血压目标。在改变患者就诊时测量血压的时间后，有 73.3%的患者达到了目标（没有显著变化）。然而，在实施 EMR 提醒后，达到目标血压的患者比例有了统计学上的显著改善，达到 76.8%（p<0.01）。这一减少是由最初血压升高但在重复测量时降至目标范围内的患者百分比高所驱动的。尽管进行了多次测量仍高于目标的患者，可以转介到新的药剂师主导的高血压诊所，以确保充分的随访和药物调整。确保在诊所中正确测量血压并遵循最佳实践非常重要。使用单次诊所血压测量可能导致过度治疗高血压。虽然患者就诊时测量血压的时间并不重要，但重复测量高血压确实可以增加门诊糖尿病诊所达到血压目标的患者数量。
